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General NPI Number Information
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NPI Number | 1386198422
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Entity Type | Individual
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Provider Name | BRADFORD RICHARD MATTISON D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1 HOLLIS ST STE 340
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City | WELLESLEY
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State | MA
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Zip | 02482
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Country | US
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Telephone | 781-235-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 115 LANGLEY RD # 2
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City | NEWTON
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State | MA
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Zip | 02459-2062
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857389
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License Number State | MA
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